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Using AI to negotiate a $195k hospital bill down to $33k

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Re: Using AI to negotiate a $195k hospital bill down to $33k

#521

Post by tptacek »

wing-_-nuts wrote: post #509
tptacek wrote: post #317

Earlier quoted context omitted.

Yes, a challenge for major structural alterations to the American system is that the median American family is probably better off under this system than they would be under any of the European-style systems: the wage premium enjoyed by many Americans and the lower tax level offsets the cost of insurance and copays. So when you're talking about how bad the American system is, you're really talking about a minority of…

>the median American family is probably better off under this system than they would be under any of the European-style systems: the wage premium enjoyed by many Americans and the lower tax level offsets the cost of insurance and copays. If you had said the median tech worker? I might have believed you, but the median family? No way.

The median family of 4 with private health insurance has a household income of around $115k not counting the gross cost of their employer-provided health care. Remember: being on private insurance puts you in a cohort that:

* Excludes everybody on Medicaid

* Excludes fixed-income seniors on Medicare

* Makes it overwhelmingly likely you have subsidized employer-covered health insurance.

Figure your employer "covers" half the gross cost of your $24k/yr health insurance (they aren't, really: that's money they'd be paying you directly without the distortion of employer-provided health care). Do the take-home pay math. Put them in, like, Ohio, or Iowa, or Colorado; just not SFBA or NYC.

Now move that same family to Manchester, take the wage hit for moving to the UK labor market, and work out the take-home pay. They'll of course pay $0 for the NHS.

Are they better off or worse off?

I'm not valorizing the arrangement, I'm making a point about how political tractable changing it is.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#522

Post by phil21 »

throwway120385 wrote: post #482
Aurornis wrote: post #469

Earlier quoted context omitted.

Also very true, and a good point. Even people in the US don't understand why those $200K hospital bills aren't real. Insurance providers (including government programs) have a fixed limit for what they pay for procedures. They pay min(billed_amount, allowed_amount) so providers don't want to risk leaving money on the table by having billed_amount So every time you see posts on the internet where people talk about the…

That depends a lot on your insurance. For example, our out of pocket for my son's birth was somewhere in the neighborhood of $10k after insurance. I've met tons of people who would be bankrupted by that amount. What you're describing isn't true for people on High Deductible Health Plans, and those plans are a bit of a racket because they're frequently paired with HSAs where the employer gets to pocket anything left i…

HSA is your money like a retirement account is. It’s one of the most tax advantaged ways to save money.

More or less all high income earners who do not have a chronic health issue are better off choosing a HDHP paired with a HSA - especially if the company provides any sort of matching benefit. Keep that account as an additional retirement account and pay out of pocket for most healthcare needs.

Think of it also as actual insurance vs. a pre-paid health plan.

The math of course changes for folks who are not highly paid, or have expensive chronic health conditions that would result in maxing out the deductible each year.

You are likely thinking of a FSA which is use it or lose it.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#523

Post by tptacek »

sumeno wrote: post #517
tptacek wrote: post #445

Earlier quoted context omitted.

Implicit in all these stories is that "education" means "access to highly selective universities". In-state tuition at Directional State University is much more manageable.

Not really. I went to a public land grant university 20 years ago and paid about $12k a year in state. That same university is now $44k per year.

Both my kids went to UIUC and we paid about $15k/yr, and both my kids graduated within the last couple years. And UIUC isn't a Directional State University; it's the flagship of the UI system. You can just look this up: tuition numbers aren't secret.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#524

Post by wing-_-nuts »

_heimdall wrote: post #334
egorfine wrote: post #253

Earlier quoted context omitted.

[flagged]

I don't think this has much to do with being a democracy. I, for one, wouldn't trust our federal government to competently run an efficient, most uncorrupted healthcare system for all. The incentive structures that have built up around US politicians simply doesn't leave any room for it to realistically happen. Until the incentives are changed I'd vote against nearly any major government program.

I hope you refuse Medicare at 65 under those same principles

Re: Using AI to negotiate a $195k hospital bill down to $33k

#525

Post by Capricorn2481 »

Workaccount2 wrote: post #341
Capricorn2481 wrote: post #238

Earlier quoted context omitted.

Wildly false. This thread is full of people sharing stories of being supposedly "insured" and getting fucked anyway. The complete lack of transparency around what your insurance covers, something you can't be expected to verify while in the middle of a dire medical crisis, can lead to a life destroying bill. Nobody should have to be wondering what company an ambulance works for. It's crazy. The whole world thinks it'…

I don't know what I said that is wildly false. Or even false for that matter. People getting surprise bills that their insurance will not cover is rare, because being in a situation where it's a possibly is rare. Insurance pre-approves or denies care before it is done, so you really need to be in the ER and getting odd-ball care that falls outside standard procedure. I'm also not defending them system, it is a mess (…

I know you were just explaining why America puts up with this, but it's not my opinion that everyone does prioritize inflation over healthcare. It's a core issue for a lot of people.

> People getting surprise bills that their insurance will not cover is rare

Define rare. Because millions of people per year are forced into uninsured ER visits.

> A better way to think of this is like bad car accidents

A hard disagree.

Most people avoid the hospital until they need to go to the ER, because taking time off work to find out if you're even allowed to be treated is prohibitive. I can't talk to any medical professional anymore without going in. And with the doctor shortage, if I go to a hospital, I will be dismissed unless I'm experiencing severe sickness or pain because I'm wasting their time.

People are driving all the time. People avoid the hospital as much as possible, because they are understaffed and predatory, and there are many pitfalls where you can be ripped off. This is all assuming you even know how this stuff works. Not everyone realizes an uninsured visit could cost as much as a house. You don't get the bill until it's done. That's the fucked up part.

I don't know a single person making under 100k who is comfortable with their healthcare situation. They are terrified to be unconscious or misinformed, making a mistake that could financially cripple them for life. There are no guardrails for this. Yet there is more vitriol for AWS bills then there are for the healthcare system.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#526

Post by tptacek »

tracker1 wrote: post #493
lotsofpulp wrote: post #437

Earlier quoted context omitted.

> so they instead just grow the pie larger by inflating everything So why would they deny coverage? All they have to do to earn more money is keep paying for more and more healthcare.

Because they make more by not paying than by paying... When the payouts are larger, they raise premiums, make money on both sides. Not to mention, if they can delay payment for a month, that's a month worth of interest on the money in an interest bearing account.

How exactly do they make more money by not paying? They're required to spend 80% of their funds on provider expenses. The only obvious way to sustain the narrative that insurers are distorting the system for profit is the preceding comment's hypo that they'd be over-paying (and then driving rates up as their expenses increased). You propose the opposite fact pattern here.

(Net cost of health insurance, all expenses, is around 6.5% of total US spending, as against 51.5% of direct provider costs for doctors, nurses, and procedures, not counting prescriptions.)

Re: Using AI to negotiate a $195k hospital bill down to $33k

#527

Post by ziofill »

egorfine wrote: post #253
chrisgeleven wrote: post #245

I fought insurance over this past summer after they declined covering a life saving surgery for my 6-year-old child at the last minute. We were in despair that my child's life was at risk each day we waited because of insurance incompetence. ChatGPT literally guided me through the whole external appeal process, who to contact outside of normal channels to ask for help / apply pressure, researched questions I had, hel…

[flagged]

Non-US person here too. From what I understand the majority of Americans want a single-payer healthcare system, but too many people in government are paid by insurance companies and affiliates to not change how things work.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#528

Post by iAMkenough »

like_any_other wrote: post #222
ecosystem wrote: post #74

The American Medical Association owns copyright to all the codes and their descriptions. They have an extremely restrictive and expensive licensing options and they strictly forbid training models with the codes. This month, the practice was called out ( https://www.help.senate.gov/rep/newsroom/press/chair-cassidy... ) so the Overton window may be opening. The AMA (a nonprofit!) clears ~$300M/year revenue from the co…

So what you're saying is the AMA is openly hostile to Americans.

You could argue the lawmakers that granted copyright protections are openly hostile to Americans. Many fine people are saying that Congress values profits over people.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#529

Post by dragonwriter »

egorfine wrote: post #253
chrisgeleven wrote: post #245

I fought insurance over this past summer after they declined covering a life saving surgery for my 6-year-old child at the last minute. We were in despair that my child's life was at risk each day we waited because of insurance incompetence. ChatGPT literally guided me through the whole external appeal process, who to contact outside of normal channels to ask for help / apply pressure, researched questions I had, hel…

[flagged]

> I have heard the US is a democracy.

It is certainly not a direct democracy where each individual policy is resolved by separate independent voting, no.

> So then insurance-based healthcare is what American people truly want?

Pretty consistently, no, but there is not any single alternative that a majority of the American people prefer recently (for a while, as far back as the 1990s, there was a clear popular majority for universal single-payer), and more importantly, it is not the only issue that factors into people’s voting decisions.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#530

Post by lawn »

Workaccount2 wrote: post #177
lifeisstillgood wrote: post #108

The rest of the western world just looks at this as wonders why Americans put up with this. Using the latest in technology to move an a bill from existential to merely crippling

Because 92% of Americans have health insurance, and 22% have totally free everything covered health insurance. Of the uninsured, most either are eligible but don't apply, have insurance through work but forgo it, or are not US citizens. All said and done, you end up with a very small sliver of people who are legitimately uninsured, which means the problem mostly exists as scary stories rather than people actually exp…

Except if you have health insurance and the medics choose the "wrong" medicine which isn't covered by your particular insurance.

Or when an ambulance from the wrong company shows up.

Or as in OP when the hospital makes up the charge.

And add the 8% of uninsured Americans, which is still almost 30 million people!

Only in America will this all add up to "scary stories" and they will shrug and defend the system.

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